title: Intervention to reduce parental bypass of community pediatric primary health facilities in asmara, eritrea.
abstract: OBJECTIVE
  To reduce direct parental referral of low acuity ill pediatric patients to the outpatient facilities of a nation's only pediatric referral hospital.
  
  
  METHODS
  Longitudinal monitoring of outpatient visits at Orotta Children's Hospital (OCH) and primary health facilities (PHFs) following implementation of an intervention designed in response to information provided by parents and health-care providers. Parental surveys were undertaken before and after exposure to the intervention to assess effects on knowledge, attitudes, and behavioral intentions.
  
  
  RESULTS
  We analyzed 5,639 visits between baseline and follow-up, documenting a decline in parental referral among OCH outpatients from 95% to approximately 80%. Educational intervention increased the proportion of parents intending to use PHF for future outpatient care from 28% to 82%. Staff of the PHFs responded enthusiastically to this intervention program and requested further activities.
  
  
  CONCLUSIONS
  Self-referral to tertiary care hospital was reduced following a modest program of parental education designed and implemented by residents in training.
authors.affiliation: Department of Pediatrics, UC Davis Medical Center, University of California, Davis, Sacramento, CA, USA.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Natale
authors.forename: Ellen
authors.initials: E
authors.lastname: Hamburger
authors.forename: Mussie
authors.initials: M
authors.lastname: Aman
authors.forename: Woldu
authors.initials: W
authors.lastname: Asmerom
authors.forename: Amal
authors.initials: A
authors.lastname: Faisal
authors.forename: Fitsum
authors.initials: F
authors.lastname: Gebremichael
authors.forename: Solomon
authors.initials: S
authors.lastname: Haile
authors.forename: Meroni
authors.initials: M
authors.lastname: Maekele
authors.forename: Mahmud
authors.initials: M
authors.lastname: Mohammed
authors.forename: Dawit
authors.initials: D
authors.lastname: Tesfaye
authors.forename: Belai
authors.initials: B
authors.lastname: Ghiorghis
authors.forename: Jill G
authors.initials: JG
authors.lastname: Joseph
keywords: community health; developing nation; health services accessibility; pediatric; primary care